Institute For Healthcare Improvement’s
100k lives Campaign
Clint MacKinney, MD, MS
clintmack@cloudnet.com
Duluth, Minnesota
July 19, 2005
2005 Minnesota Rural Health Conference
Topics for Today
1. The 100,000 Lives Campaign
2. Why is the Campaign important
3. Why rural and why us
4. The Campaign’s current status
5. The interventions
6. Resources to get started
7. Opportunities and barriers to involvement
(discussion)
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2005 Minnesota Rural Health Conference
A Flawed System
“Between the health care we have and the
health care we could have lies not just a gap,
but a chasm.”
– Crossing the Quality Chasm, 2001
Health care does not yet reliably transfer best-known science
into practice, and processes frequently fail, despite the best
intentions of a dedicated and highly skilled workforce. Our
system, which intends to heal, too often does just the
opposite – leading to unintended harm and unnecessary
deaths at alarming rates.
– 100k Lives Campaign folder, 2004
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2005 Minnesota Rural Health Conference
Background
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2005 Minnesota Rural Health Conference
Six Changes that Save Lives
1. Deploy Rapid Response Teams*
2. Deliver Reliable, Evidence-Based Care for Acute
Myocardial Infarction (Heart Attacks)*
3. Prevent Adverse Drug Events (ADEs)*
4. Prevent Surgical Site Infections*
5. Prevent Central Line Infections
6. Prevent Ventilator-Associated Pneumonia
*Rural-appropriate interventions
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2005 Minnesota Rural Health Conference
Healthcare Safety?
• < 98,000 deaths per year due to medical errors
– Institute of Medicine, 1999
• 195,000 deaths per year due to medical errors
– HealthGrades, 2004
• How many is too many?
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2005 Minnesota Rural Health Conference
Healthcare Quality?
The Quality of Health Care Delivered to Adults
in the United States – McGlynn et al
Results
• Participants received 54.9% of recommended care.
• 45% defect rate!
Conclusions
• The deficits we have identified in adherence to
recommended processes for basic care pose serious
threats to the health of the American public.
NEJM. Volume 348:2635-2645. June 26, 2003. Number 26
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2005 Minnesota Rural Health Conference
Healthcare Value?
30%
70%
Costs of Poor
Care
Appropriate
Health Care
Costs
Causes of poor care: Misuse, underuse, overuse, waste – Juran Institute and Midwest
Business Group on Health. 2003
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2005 Minnesota Rural Health Conference
Why Rural; Why Us?
• 30% of Minnesota’s population is rural
• The “big” systems have already signed on
• Our interest in improvement, and our need
for improvement, is no less significant
• Our patients, families, and communities are
no less cherished
• Only interventions that make sense for rural,
for our hospitals, and for our communities
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2005 Minnesota Rural Health Conference
If not for statistics, then for our future
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2005 Minnesota Rural Health Conference
Participation May 2005
• Over 2,200 hospitals enrolled in all 50 states
• Nearly 50% of U.S. hospital beds
• Thousands on national calls
• Unprecedented web activity and new tool
development
• Related campaigns forming globally
• Data collection underway with Pioneer
Group; begins for all enrollees 6/14/05
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2005 Minnesota Rural Health Conference
Participation May 2005
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2005 Minnesota Rural Health Conference
Changes Proven to Prevent Avoidable Death
• Rapid Response Teams
– Cardiac arrest or shock
occurs in 0.6% of medical
patients and 0.5% of
surgical patients.
– Only 17% of patients who
experience a cardiac arrest
survive to discharge.
– Most patients who have inhospital cardiac arrest have
identifiable signs of
deterioration prior to arrest.
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2005 Minnesota Rural Health Conference
Changes Proven to Prevent Avoidable Death
• Improved Care for Acute
Myocardial Infarction
– 1.1 million experience an AMI
yearly. 1/3 die acutely.
– Implementation of guidelines
reduces mortality.
– Yet in AMI, only 61% receive
aspirin and only 45% receive
beta-blockers.
– AMI care included in
• CMS’ Hospital Quality Initiative,
• JCAHO’s core measure set.
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2005 Minnesota Rural Health Conference
Changes Proven to Prevent Avoidable Death
• Prevention of Adverse
Drug Events
– 1,200 hospital deaths in
1993 were due to medication
errors.
– 6.3% of malpractice claims
are due to medication errors.
– 46% of all medication errors
occur at care transition
points.
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2005 Minnesota Rural Health Conference
Changes Proven to Prevent Avoidable Death
• Prevention of Surgical Site
Infection
– Surgical site infections (SSIs)
account for 14% - 16% of
hospital-acquired infections.
– Among surgical patients,
SSIs account for 40% of
hospital acquired infections.
– Surgical patients who
develop SSIs are twice as
likely to die as other surgical
patients.
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2005 Minnesota Rural Health Conference
Changes Proven to Prevent Avoidable Death
• Prevention of Central LineAssociated Bloodstream
Infection
– 48% of ICU patients have
central venous catheters, or
15 million catheter days per
year.
– There are 5.3 venous
catheter-related bloodstream
infections per 1,000 catheter
days.
– Approximately 14,000 deaths
per year from venous
catheter-related bloodstream
infections.
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2005 Minnesota Rural Health Conference
Changes Proven to Prevent Avoidable Death
• Prevention of VentilatorAssociated Pneumonia
– Ventilator-associated
pneumonia (VAP) occurs in
15% of patients receiving
mechanical ventilation.
– Mortality for mechanical
ventilator patients with VAP
is 46% compared to 32% for
those without VAP.
– VAP is associate with
prolonged mechanical
ventilation, ICU stay, hospital
stay and associated
increased costs.
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2005 Minnesota Rural Health Conference
Resources – IHI
• www.ihi.org/IHI/Programs/Campaign/
– Platform materials for each intervention
• How-to Guide for implementing the change
• Presentation with facilitator notes
• Annotated bibliography
– Campaign activity checklist
– Getting Down to Work: Field Operations,
Implementation, Measurement, and Next Steps
– Customizable press release
– Data submission how-to guide
– Multiple informational calls, videos, web discussions
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2005 Minnesota Rural Health Conference
Resources – Minnesota
• Minnesota Node – 60-70 hospitals signed on!
– Stratis Health (Minnesota’s QIO)
• Acute Myocardial Infarction, Adverse Drug Events, Surgical Site
Infections
– Institute for Clinical Systems Integration
• Rapid Response Teams, Central Line Infections
– Minnesota Hospital Association
• Ventilator Associated Pneumonia
• Contact
– Julie Apold, MHA Patient Safety Manager
– japold@mnhospitals.org
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Resources – www.mnpatientsafety.org
"Promoting optimum
patient safety through
collaborative and
supportive efforts
among health care
organizations in
Minnesota"
The Minnesota Alliance for
Patient Safety was established in
2000 as a partnership between the
Minnesota Hospital Association,
Minnesota Medical Association,
Minnesota Department of Health
and more than 50 other publicprivate health care organizations
working together to improve
patient safety.
2005 Minnesota Rural Health Conference
Some Is Not a Number… Soon Is Not a Time
The Number:
100,000 Lives
The Time:
June 14, 2006
9 am ET
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